A Paper read before
the Canadian Military Institute, Toronto, March 6th, 1899. and
reprinted from the Canadian Practitioner and Review, April, 1899.

It was with pleasure, not unmixed with fear and trepidation —a fear
born of knowledge of my own unworthiness and of the great merits of
the lecturers who have preceded me, and, perhaps, of the keen and
well-informed critics that I see before me—that I accepted the
flattering offer of the committee to address you to-night on the
subject of the medical service of the Imperial army and of the
Canadian militia.

It may not be out of place to say that my mind has long been
directed to military medical affairs, and that I ascribe this fact
as being due in no small degree to the influence of a great painting
which adorned, and still adorns, the walls of the auditorium of the
Faculty of Medicine of Paris. The picture represents a sixteenth
century battle-scene. In the distance are groups of men engaged in
combat. In the foreground is an operating table, on which is
strapped and held by the blood-stained assistants, a powerful man
who has just had his leg lopped off by the old circular method. To
the right of the picture is a brazier filled with glowing charcoal,
in which repose several cautery irons, one of which is being handed
to the king, who offers it to the surgeon, Pard Beneath the picture
in letters of gold runs the legend, “The King aids their efforts and
rewards their zeal.” Gazing upon this painting day after day as I
followed the lectures, the idea came to me that I would like to
become an army doctor. It was not rny fate to enter the service of
the Imperial army, but on the completion of my education abroad I
made what haste I could to enter the militia medical service of my
native country, on my return to Canada.

Military surgery has kept pace with the scientific advance of the
century, and the field surgery of to-day differs as greatly from the
septic scenes of horror of the sixteenth century as the telegraph
does from pony express.

During the bloody civil war in the time of King Charles I. some
attempt was made to organize the English medical service; for we
read of regimental mates, hospital mates, regimental surgeon,
surgeon to a general hospital and surgeon-general, as being
recognized ranks in the army of that unhappy monarch. But it was
during the wars of Marlborough that the British army medical service
took form and increased efficiency. Previous to that time soldiers
who were so seriously maimed as to be rendered ineffective, were
simply discharged, the State believing that it was cheaper to hire
whole men than to restore the sick and the maimed to health. It
declined to be held responsible for those who suffered in its
service, and let them shift for themselves as best they could. The
morality of the proceeding did not seem to enter into the question.
There was no clear distinction between the land and sea service,
though there was between physicians and surgeons, and it was no
uncommon thing to hold double commissions, combatant and
non-combatant, the holders serving in either capacity as suited
their interests or convenience. The services were separated in 1796.
In Marlborough’s time it was considered effeminate to be sick, and
there are lusty yokels who hold that view still, but the bloody and
exhaustive battles of the time, and especially in the low countries,
where malaria stalked its prey unchecked, brought the strongest to a
sense of their fallibility. ..

As in all stressful periods of British history there arises the man
for the emergency, so at this trying period, Marlborough’s principal
medical officer, Sir John Pringle, proved himself an able
administrator, a man of courage, of indomitable energy, with the
service of his country and the honor of his profession ever
uppermost in his mind. Under circumstances of the greatest
difficulty and under every disadvantage, he rose to the needs of the
occasion and organized a system of regimental, field, and general
hospitals. The first general hospital was opened at Ath, May 11th,
1745, and, after the battle of Fontenoy, cared for 600 wounded. It
was not, however, until many years later, during the Peninsular war,
that surgeons were first assigned to regiments in the field. Sir J.
McGrigor, the P. M. 0. under Wellington, a man of energy and
ability, devised the regimental system of medical officers which has
held sway until recently in the Imperial army, and which holds good
to-day in Canada. That the medical officers were active and
efficient will be admitted when it is stated tKat in ten months from
the siege of Burgos up to the battle of Vittoria, the total number
of sick and wounded admitted to hospital was 95,348; yet on the eve
of the battle there were only 5,000 sick in hospital, the vast
majority of the 95,000 having returned to duty.

In 1812 a corps called the Royal Waggon Corps was organized, special
waggons with springs being constructed for the conveyance of sick
and wounded. This corps was disbanded in 1833.

In 1854, on the outbreak of the Crimean war, the Hospital Conveyance
Corps was called into existence. That it was not a success was
chiefly owing to the total want of special training of the men for
their duties, and because the medical officers had no authority over
the men.

It was followed by the Land Transport Corps. This corps also came to
grief because there was no cohesion or organization which would
work, and because it fulfilled but one function required of it,
viz., the conveyance of the wounded. The important duties of
attending to wounded on the field and in hospital were not provided
for. In consequence of all these failures the first Medical Staff
Corps was organized in 1855. It consisted of nine companies of
seventy-eight men each, “to be employed in any way that may be
required in the performance of hospital duties.” There were scarcely
any military features in this corps, and it also collapsed in about
three months. The chief cause of failure was the doubtful and
anomalous relations of the medical officers to the combatant
authorities. The medical officer had no military authority, hence no
power of enforcing discipline.

On September 15th of the same year, this corps gave place to the
Army Hospital Corps, which possessed full military organization. The
ranks were chiefly recruited by transfer from the combatant ranks of
men of good character. Each man spent three months on probation in a
military hospital before being finally enrolled in the corps. It was
under the command of captains and lieutenants, of orderlies and
quartermasters.

In 1858 a Royal Commission, under the presidency of Right Hon.
Sidney Herbert, brought in a report which remodelled the department
and established the army medical school.

In 1873 Mr. Cardwell, Secretary of State for War, the author of so
many army reforms, abolished the regimental system by Royal Warrant
and placed all medical officers on a staff. Regimental hospitals
disappeared under this warrant, and became part of station or
general hospitals, as the case might be.

In 1877 medical officers were given authority over the A. H. Corps,
non-commissioned officers and men, as well as patients in hospital
and soldiers attached for duty.

In 1883 Lord Morley’s committee made recommendations, which were
adopted, the principal ones being the vesting of the control of
hospitals in the medical officer in charge, and the assimilation of
the A.H.C. and A.M, Department, both to wear the same uniform (blue
with black facings).'

In 1889 a committee, under Lord Camperdown, was appointed to make
inquiries into the pay, status, and condition of the medical
service. One of the committee’s recommendations was the adoption of
military titles, prefixed by the word “surgeon,” as, for instance, “
surgeon-lieutenant-colonel/’ etc. These titles carried precedence
and other advantages, but a limited executive power, hence they were
found unsatisfactory.

By Royal Warrant of July 1st, 1898, the medical staff corps became
the Royal Army Medical Corps, and medical officers were given full
military titles. The duty of supplying transport to the R.A.M.C.
devolves upon the Army Service Corps, the officer commanding the
detachment taking his orders from the senior officer of the R.A.M.C.

Regiments which have served in the great battles of history are
justly proud of the deeds of their predecessors, and emblazon the
names of the regiment’s battles in golden letters on their colors,
while esprit de corps runs high. Should we not also be proud of the
medical corps of the Imperial army, which has served with
distinction and fidelity in every battle since Marlborough’s time ?
Soldiers have their heroes. We also have ours. The names of Ambroise
Par^, Peter Lowe, Richard Wiseman, Larrey and Longmore are
emblazoned on the annals of military medicine. Nor have medical
officers been lacking in military courage. “Have you ever heard of
Surgeon Thomson, who, during the Crimean war, when the army marched
off after the terrible battle of the Alma, volunteered with his
servant to remain behind on the open field with 500 wounded
Russians, and passed three awful nights, these two Englishmen alone,
among foreign foes, none able to raise a hand to help himself? Have
you heard of Assistant Surgeon Wolseley, of the 20th regiment, who,
at the battle of Inkerman, had quietly established his dressing
station in that awful place, the Sandbag Battery? When the 150 men
were forced to desert it, they fell back and found in their path a
Russian battalion. There was not a combatant officer left, so the
assistant surgeon took command. He had not even a sword, but laying
hold of a musket with a fixed bayonet, he gave the word of command,
‘ Fix bayonets. Charge.’ The soldiers answered with a British cheer
and sprang forward to the attack. The next instant they were
breaking their way through the Russians. Only one-half got through
alive, and among them our hero. Have you ever heard of Surgeon
Landon, who was shot through the spine while attending to the
wounded on Majuba Hill ? His legs were paralyzed, but he caused
himself to be propped up, and continued his merciful work until his
strength ebbed away. You may recall the more recent case of
Surgeon-Captain Whitchurch, who gained the Victoria Cross at the
siege of Chitral for the most determined courage in saving the life
of Major Baird.

“There died a short time ago a certain Surgeon-General Reade, C.B.,
Y.C. During the siege of Delhi, while attending to the wounded at
the end of one of the streets of the city, a party of rebels
advanced from the direction of the bank, and having established
themselves in the houses of the street, commenced firing from the
roofs. The wounded were thus in very great danger, and would have
fallen into the hands of the enemy had not Surgeon Reade drawn his
sword, and calling on a few men near him to follow, succeeded, under
a very heavy fire, in dislodging the rebels from their position.
Surgeon Reade’s party consisted of ten in all, of whom two were
killed and six wounded.” Surgeon Reade was a Canadian, and one of
the two sons of a colonel in the militia, both of whom greatly
distinguished themselves. I might add that of 118 wearers of the
Victoria Cross fourteen are surgeons, nearly 12 per cent, of the
whole number, or 9J per cent, of all the officers of the army, a
record of which we may be justly proud.

Knowing the brilliant and meritorious services of army medical
officers it gives one a shock to learn that it was only after many
failures, many struggles and much heart-burning, after a prolonged
period of unjust treatment, which, to the colonial mind is
incomprehensible, that the medical service of the Imperial army has
reached the present point of high efficiency and excellent
organization—a state of things largely due to the tenacity with
which the leaders in the struggle have stuck to the text, and the
cordial and active support which they have received from the medical
profession throughout the empire, chiefly through the medium of the
British Medical Association. We, in Canada, have all the advantage
which comes from the experience of others without the trials and
anxieties which attend the gaining of experience, and I am happy to
think that nothing but the best of feeling has always existed
between the different branches of the service. No better proof of
this can be adduced than that we have as the responsible Minister of
Militia and Defence, an able, open-minded and progressive medical
officer, Surgeon Lieut.-Colonel the Hon. F. W. Borden, M.P., who has
the very great advantage of the assistance of one of the ablest and
most tactful general officers by whom the Canadian militia has ever
been commanded. Under the united guidance of the soldier and the
SURGEON, I look forward with confidence to the future.

Having thus sketched the historical and evolutionary side of my
subject, let me direct your attention to the practical work of the
medical service in so far as organized relief and transport of the
wounded are concerned. In order to understand the way in which a
wounded soldier is brought from the fighting line to the base
hospital, it is necessary to refer to the composition of a British
army corps in the field. Such an army corps would consist of about
40,000 men, about the strength of our militia, under, the command of
Lieutenant-General. It would be composed of 3 divisions of infantry,
and each infantry division would contain about 10,000 men in 2
brigades. The medical detail for each division would be, besides the
regimental bearers, 2 bearer companies, 3 field hospitals of 100
beds each, and one divisional field hospital in reserve. The corps
troops have also one field hospital. The cavalry division would
number about 6,500 men, and would have attached to it 2 bearer
companies and 3 field hospitals of 100 beds each. The whole medical
detail for the division, exclusive of regimental bearers, would be 8
bearer companies, 10 field hospitals, 2 station hospitals and 2
general hospitals, the latter being on the line of communication at
any distance up to 100 miles from the front. The supreme command of
the medical arrangements is vested in a surgeon-general, who is the
P. M. O. of the force, ' In many instances he is assisted by Deputy
P. M. O., who is a colonel. The duties of the P. M. O. are to advise
the G. 0. C. on all matters concerning the health of the troops.
This would include such important matters as food and clothing, and
any special precautions rendered necessary by the climate, also the
oversight of his department. The importance of his functions can
hardly be overestimated, for his business is to direct the measures
for keeping the men in health, which is the main business of the
army surgeon, so that at the critical time they be available.

The last Ashanti campaign was, you will remember, a “doctors’ war.”
Nor would Khartoum have fallen, nor would Omdurman have been
successfully fought but for the skilful foresight of the men who
kept the troops in health in the trying climate of Upper Egypt.
Thanks to the excellent medical arrangements, a tour of service in
India is no longer a thing to be dreaded The P. M. O. has also to
arrange for the transport of the sick, and wounded, no small matter
in a difficult country, and to fix the sites of the field,
stationary and general hospitals. Each division has also its P. M.
O.

The first line of assistance to the wounded consists of the M. 0.
attached to the unit and his regimental medical staff, Which is
composed of one corporal, whose duties are to take charge of the
panniers, which are usually carried on a mule; one orderly who
carries the field companion and the surgical haversac. Four men per
squadron, or two men per company, constitute the stretcher section.
The medical equipment of the unit consists of one surgical haversac,
one field companion, one water-bottle and a pair of panniers. The
duties of the stretcher-bearers,. when an action is pending, are,
after placing their rifles in the regimental transport, to take the
stretchers, and when occasion arises to render first aid, and carry
the wounded man and his kit to the collecting station, beyond which
they do not go, but at once rejoin their companies. Lord Wolseley
says that when a man falls wounded there are ten men always ready to
take him to the rear. I have found this to extend to dead bodies.
The solicitude of men in action to get to the rear on a fair excuse
is remarkable. The first aid dressing, which every man carries in
the field, is done up in a waterproof cover, and is sewn up inside
the man’s tunic pocket! It consists (1896) of two safety pins, gauze
bandage and piece of gauze, and a compress of charpie saturated with
an antiseptic (bichloride of mercury). During the late
Spanish-American war these first aid dressings are said to have
saved many lives. At the collecting station the man is seen by the
medical officer, who arrests hemorrhages and attaches a tally on
which is stated the man’s name, number, rank, regiment, wound,
treatment, and any special instructions required, such as, “ look
out for bleeding,” or to place the patient in a particular position.
In the Italian army tallies of different colors arc used for severe
or slight injuries.

I now come to the second line of assistance, the Bearer Companies.
They are departmental, and are formed by the Royal Army Medical
Corps. They are divided in action as follows: In front (that is, in
rear of the fighting line), 38 of all ranks; at the collecting
station, or in charge of the waggons, 12; at the dressing station,
10, including three medical officers; and in rear, 10. The front
division of the bearer company does similar work to that of the
regimental stretcher-bearers, i.e., they render first aid and carry
wounded to the collecting station. As they arrive at this point they
are ^plkced in one of the ten ambulance waggons in waiting and taken
to the dressing station. Each waggon is in charge of a
non-commissioned officer of the R.A.M.C. On arrival at the dressing
station the wounded are unloaded and placed in two groups—on the
right the severely wounded, and on the left the slightly wounded.
The site of the dressing station is always sheltered, if possible
near a good road and water, and not far from the collecting station.
Here it is that the wounded receive proper treatment and primary
operations are performed. At the close of the action the bearer
companies search the woods and ditches for wounded. In Germany this
work, at night, is done with the aid of dogs, on whose backs are
first aid panniers and lamps.

From the dressing station the wounded are passed on to the third
line of assistance, the Field Hospital. A Field Hospital is attached
to each brigade, and on the line of march follows the bearer
companies. These hospitals are mobile, and keep in close touch with
the troops. After or during an action the site of a field hospital
should be out of range of artillery fire and well sheltered.
Buildings may be used, but churches should be avoided, as they are
apt to be damp, cold and ill-ventilated. Their only advantage is
their proximity to the graveyard. Collecting and dressing stations,
field hospitals and bearer companies are under the Red Cross, but
regimental bearers are not, for they carry arms and are available in
case of necessity as combatants. In wars on savage peoples all ranks
may have to fight, as, for instance, at Rorke’s Drift. Hospitals fly
the Geneva Red Cross flag by day, and show two white and one red
lantern at night.

As soon as possible wounded are passed out of the Field Hospital
into the fourth line of assistance, the Stationary Hospital. They
are gradually drafted out of this into the fifth line of assistance,
the General Hospital, a large hospital containing 400 beds, and in
charge of a Colonel, R.A.M.C.

The sixth line of assistance is the hospital ship; and the seventh
and last is the Royal Victoria Hospital, Netley. The principal
object in view, after treatment, is to “ clear the front of wounded
men,” who impede the movement of the army.

Having said so much on the historical and other aspects of the
Imperial Medical Service, permit me to add a little about the past
and future of our own militia medical arrangements. It is strictly
within the facts that our medical service is in a lamentable and
unorganized condition. If we were suddenly plunged into war, we
would suffer as serious disasters as befell the army of the United
States during the late Spamsh-American war. This war has clearly
demonstrated that trained army surgeons and trained ambulance men
and transports cannot be improvised with success. The result of such
a course is untold suffering to the troops, great loss of life,
which might have been avoided, and discredit upon a department which
did its best, but had a numerically insufficient staff to work with.
Let us take the lesson of this war to heart and profit by the
painful and costly experience of others, rather than wait to learn
the lesson for ourselves at a great price of blood and treasure.

Up to 1862 the supplies to camps of instruction left much to be
desired, to put it mildly. The surroundings of the sick in many
camps of instruction could hardly have been worse. I am not claiming
too much for the Association of Medical Officers when I state that
to that association belongs the credit of drawing professional and
public attention to much-needed reforms. Let us hope that the
reforms and improvements which have already been made merely precede
a complete reorganization of the Medical Department, under our able
Director-General.

I would respectfully submit that the following are among the changes
which might properly be made to place the department on an efficient
basis:

1. Abolition of the regimental system of medical officers, and the
formation of a Royal Canadian Militia Medical Corps, to which all
medical officers would belong; those not serving with units or on
the reserve would be attached to bearer companies. I believe more
efficient work would be done by officers whose interests were
identified with departmental rather than regimental affairs. I would
not advocate a sudden and violent change in this regard, but rather
would suggest that all present medical officers be permitted to
continue to wear the uniform of the corps to which they are
attached, but I think that all new appointees might be required to
adopt medical staff uniform. Medical officers attached to battalions
would command the regimental medical staff. The departmental
establishment would include at least five bearer companies—one each
at Halifax, Montreal, Toronto, London and Winnipeg. From the bearer
companies field hospitals could be developed in time of war.

The grades in the medical service, in my humble opinion, should be :
Surgeon-Colonel, Surgeon Lieutenant-Colonel, Surgeon-Major,
Surgeon-Captain, and Surgeon-Lieutenant. Honorary rank should be
abolished. It is as unsatisfactory as relative rank.

These bearer companies would be educational, because at the centres
named a certain proportion of the strength could be recruited from
medical students, who might be trained for the medical service. I
might add that all Canadian militia is “royal” since 1814;
therefore, the proposed title of the corps is in accordance with
fact.

2. I think it is essential to good work, by the medical officers,
that they shall receive instruction in their special duties, and
that they shall be proficient in company and ambulance drill. The
same remark applies to the non-commissioned officers and men of the
regimental medical staff. For this purpose I would advocate the
establishment of ambulance schools of instruction on the plan of
those in operation in London and in New South Wales.

3. Medical officers, like combatant officers, should pass a
qualifying examination within twelve months of their appointment,
which should be provisional, and not to a higher rank than that of a
lieutenant, and upon promotion to field rank.

4. Each military district should have a principal medical officer,
in most cases a permanent officer, but not necessarily in all.

5. Medical officers should be given control of transport and
supplies for hospital purposes, food and medicines, and authority
over all connected with the hospitals in camps of instruction or
during other service in the field.

6. On all field days the medical department should be exercised in
their special duties, a certain proportion of men being supplied
with tallies describing the nature of their supposed injuries, and
ordered to fall out from their companies to be properly dealt with
by the medical officers and bearers. Collecting and dressing
stations should be formed in the proper manner and instruction given
by the p.m.o. of contending forces.

7. A reserve of medical officers might be formed, to include those
who have served, but who for various reasons have been obliged to
drop out of active connection with the force, and of medical men of
established reputation, who would be willing to serve in time of
war. This arrangement would give them seniority, and would assure
the department of the best surgical skill.

8. The Red Cross Society proposes to keep a register of nurses who
would be willing to serve in time of war. Their names might be noted
by the Militia Department.

9. A knowledge of the first aid to the sick and injured might be
diffused by the medical officers, by means of lectures, under the
auspices of the St. John Ambulance Association, among the officers
and men of the force.

These are some of the suggestions I desire to make. Some will meet
with approval and some with dissent. They are offered with my most
earnest wish for the welfare of the soldiers and surgeons of my
beloved native land.

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